En bloc explant with lift 1 year ago gone wrong, why are my breasts deformed? (Photos)

The pectoralis muscle can't be repaired after dual plane or split technices, that's a legend, a myth, unfeasible no matter what you read or are told, the muscle shortens and can't be reattached, however this is not the cause of your deformity, I'll be on spot and brief:
-the surgeon failed to release the lower edge of the pectoralis muscle from the breast skin, that's why... you didn't tell us but I know well this problem is affecting you... you have animation deformity, when you contract the pectoralis you develop an awful and awkward deformity; solution: releasing the muscle and splitting it from the skin, easy as it sounds, unbelievable this was not done
-the breat lift pattern, a short inverted T or Wise patter, was unproperly planned and wrongly located, that's why your breasts look odd and square; solution: breast lift pattern revision, note: not another breast life, just a re-design of the pattern.

Your case is not a difficult one, but be sure you are not suggested artificial mesh, fat transfer, new implants, etc, it is cold and dangerous outside there, be wary and cautious, just straightworward technical proposals. No, your skin is not over streched, this is not the cause.

Hi This is Dr Özge Ergün
Thank you for this detailed surgical history.
Your analysis is precisely aligned with current challenges in reconstructive mastopexy and complex soft tissue reconstruction."
"Following the requisite phase of tissue expansion—whether for breast mound reconstruction or soft tissue deficit repair—the resulting dermal envelope, or neocutaneous flap, often demonstrates residual dermal laxity and inadequate dermal-subcutaneous unit integrity, which is not fully addressed by subsequent skin-sparing excision."
"This results in the clinically challenging sequelae of poor tissue compliance, pleating or redundancy of the skin, and crucially, non-uniform peri-implant capsular contraction that compromises the final aesthetic contour."
Strategic Recommendation: Biomechanical Augmentation
"Given the need for further volume and surface area correction, we must initiate a subsequent period of re-expansion (or revision explantation/reimplantation). However, to mitigate the risk of adverse capsular dynamics and poor dermal quality, a biomechanical augmentation is indicated."
"I propose a combined strategy: utilizing the implant for its mechanical expansive force, but integrating it with artificial tissue regeneration through techniques such as:"
1. Acellular Dermal Matrix (ADM) Placement: To provide a robust scaffold, ensuring inferior pole stability and promoting a more organized, uniform capsular deposition around the implant, thus stabilizing the pocket and improving the soft tissue-implant interface.
2. Autologous Fat Grafting (ADSC-Enriched): To deliver Adipose-Derived Stem Cells (ADSCs), which biologically enhance the vascularity and thickness of the overlying skin. This bio-enhancement improves the skin's quality, elasticity, and capacity for predictable remodeling—a critical factor for achieving superior, long-term aesthetic outcomes and contour fidelity."
"This integrated approach shifts the paradigm from purely mechanical stretching to a biologically optimized reconstruction."

Hello, and thank you for sharing your experience and photos.
After an en bloc explant combined with a mastopexy (breast lift), it’s not uncommon to see contour irregularities, loss of upper pole fullness, and shape asymmetry—especially in patients who previously had large implants placed under the muscle for many years.
When implants are removed, the breast tissue and skin envelope often do not have enough elasticity to redrape smoothly over the chest. In addition, if the pectoralis muscle was altered or detached during the earlier surgeries (as your surgeon suspected), that can also contribute to chest wall irregularity and animation deformity.
At one year post-op, the healing process is mostly complete, so if your breasts still appear deformed, there may be residual skin laxity, loss of internal support (parenchymal structure), or a need for muscle repositioning that was not done at the time of explant.
A revision procedure can often improve the shape and projection by addressing these factors. Options might include:
Auto-augmentation mastopexy using your own tissue for upper pole volume
Fat grafting to restore contour and softness
Muscle repair or internal bra techniques to re-support the breast
A detailed in-person evaluation with an experienced revision surgeon is essential to plan the best strategy for your anatomy and goals.
Warm regards,Op. Dr. Yücel Sarıaltın, MDPlastic, Reconstructive & Aesthetic SurgeonIstanbul, Turkey

Based of your photos - over the years of having implants for so long and going larger as you aged - your breast tissue got thinner and more of your breast became mostly implant and very little breast tissue, muscle and stretched out skin. Now when you remove such large volumes and not replace the volume that has been removed, you get the collapsed look where your breast just fall in and likely that is how you will be unless volume is restored at least some with another lift likely needed. Revisit with your surgeon and see what the next step is or seek out second or third opinions and see which one you match best with. But you will need another procedure to restore some volume / re-lift in order to fix some of those defects you have. Hope this helps.

I'm really sorry you're feeling this way about your outcome, it's absolutely valid to want answers and to feel frustrated after such a long journey. Long-Term Implant Effects on Tissue & Muscle could be Tissue Thinning & Stretching (20 years of implants), Implants, especially larger ones like 600cc, stretch the skin and thin out the breast tissue over time. Once the implants are removed, that skin and tissue often can’t “bounce back”, especially after menopause or near it (which impacts skin elasticity). Pocket Expansion & Asymmetry, over time, the pocket where the implant sat (especially with dual plane placement) can enlarge or migrate, creating an odd shape or “emptiness” after explant. This can cause concavity, indentations, or a “snoopy nose” deformity (where the breast tissue droops off the lower pole). Muscle Deformation or Scarring, even if your pectoral muscle wasn’t cut, it may have been stretched or distorted over the years. If muscle was partially detached during the original augmentation (as sometimes done with submuscular placement), that change might not self-correct even without visible damage now. The fact your surgeon was concerned about the tight cleavage suggests suspicion of pectoral muscle damage or alteration. Even if he didn’t see a full tear or cut, the muscle could still have been thinned, stretched, or scarred, altering breast shape. If you had animation deformity before explant (breasts moving when flexing chest muscles), that’s a sign the muscle was heavily involved and potentially compromised.

Your results are related to how your expanded skin envelope scarred back down to your chest wall. Unfortunately sometimes these outcomes are unavoidable after someone that has had large breast implants in place for long periods of time. Aggressive massage additional time may help improve your outcome however an acceptable aesthetic outcome may only be achievable with a replacement of your implants. Other options would include fat grafting, however this may take multiple rounds to achieve the desired outcome. An in person consultation with a certified plastic surgeon can give you a personalized treatment plan.

Thanks for your question! I have found that explant with en bloc can create skin deformities and can compromise breast tissue. You may benefit from some fat grafting to help improve the appearance. I would seek out a second or third opinion. Good luck!

hello and thank you for sharing your question with pictures. After a breast implant Surgery breast tissue tends to slight atrophy. After removing the implants we have less tissue to work with for a reconstruction. In your case you have retracting scar because of the lack of fat tissue. Your best option if you don't Desire to place back the implants is to fill the breast with fat transfer. Best of luck

It’s completely understandable to feel disappointed when your surgical results don’t meet your expectations, especially after allowing a full year for healing and adjustments.
In cases of breast implant removal (en bloc explantation) after a long history of having implants—especially sizable implants (like 600cc)—it’s common for the skin and breast tissues to experience stretching and thinning. Once implants are removed, even with a lift, the remaining skin and breast tissues can struggle to retract fully, potentially causing unevenness, indentations, or irregularities.
Factors contributing to these issues typically include: • Skin Elasticity Loss: After many years with implants, the skin’s ability to shrink back can be diminished. • Capsular Contracture or Scar Tissue: This tissue, which forms naturally around implants, can leave behind irregularities even after careful explantation. • Residual Scar Tissue: Scars from previous surgeries, including explant and lift incisions, can contribute to an uneven appearance. • Tissue Atrophy: Long-term pressure from implants may lead to thinning of breast tissue and fat, affecting overall breast shape and volume.
Improvement is often possible with revision procedures, such as fat transfer, secondary breast lift (mastopexy), or even internal tissue repositioning. Non-surgical treatments, such as radiofrequency skin tightening, might offer slight improvements, but significant results typically require surgical revision.
Your best step forward is a detailed in-person assessment with a surgeon experienced specifically in post-explant reconstructive surgery. They’ll provide insights into your unique anatomy and help plan the most suitable next steps.
I hope this helps provide clarity on your situation. For a detailed assessment, consulting your surgeon would be beneficial.
— Güray Yeşiladalı, MD

Loss of Volume & Support
After removing large implants (especially 600cc), the remaining natural tissue may not have enough structure or elasticity to hold a full shape, even with a lift.

Over time, the skin and tissue can sag or collapse inward, creating a “deflated” or uneven appearance.

2. Tissue Thinning from Long-Term Implant Use
After 20 years with implants, especially large ones, your natural breast tissue likely thinned out. This makes it harder for the breast to regain a rounded shape once the implant is removed.

3. Chest Wall or Muscle Changes
Even though your surgeon said no muscle repair was needed, 20 years of dual-plane implants can change the positioning or function of the pectoral muscles.

A “window shading” effect or visible muscle movement might create odd shapes, dents, or shifting.

4. Capsular Contracture or Scarring
Even after an en bloc explant, internal scar tissue from your previous surgeries may remain and cause distortion.
Sometimes scar tissue pulls or puckers the skin in a way that becomes more visible over time.
5. Inadequate Lift or Technique
If the lift wasn’t aggressive enough to reshape and reposition the remaining tissue, or if skin quality was poor, the final result might look empty, sagging, or asymmetrical.
Also, your surgeon may have been conservative to avoid complications, which can lead to underwhelming aesthetic results.

Get a Second (or Third) Opinion
Preferably from a plastic surgeon with experience in revision and post-explant reconstruction.
Bring your surgical records and imaging if available — it helps them assess muscle, tissue, and implant history.
Consider Fat Grafting or Reconstructive Options
Fat transfer can restore volume in a more natural, subtle way.
Some women opt for smaller implants or internal mesh support (like GalaFLEX) if they want more shape without going back to large implants.
3D Imaging or Ultrasound
This can help assess any internal abnormalities, muscle separation, or scarring that might be affecting your outcome.